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. 2025 Feb 3:90:e55-e65.
doi: 10.5114/pjr/199755. eCollection 2025.

Comparative analysis of diagnostic performance of automatic breast ultrasound and spectral mammography as complementary methods to mammography examination

Marta Pawlak  1 , Wojciech Rudnicki  2 , Tadeusz Popiela  3 , Lukasz Brandt  2 , Malgorzata Dobrowolska  2 , Milena Lipinska  1 , Elżbieta Łuczyńska  2
Affiliations

Comparative analysis of diagnostic performance of automatic breast ultrasound and spectral mammography as complementary methods to mammography examination

Marta Pawlak et al. Pol J Radiol. .

Abstract

Purpose: This single-centre study includes a comparative analysis of the diagnostic performance of contrast-enhanced mammography (CEM) and automatic breast ultrasound (ABUS). The study involved 81 patients with focal breast lesions, who underwent ABUS, full-field digital mammography (FFDM), and CEM.

Material and methods: A total of 169 focal lesions were found in 81 patients, of which 110 lesions were histopathologically verified, 92 were malignant, 5 were B3 lesions, and 13 were benign. On CEM 19 additional lesions not visible on other imaging examinations were found, and as many as 36 new lesions were detected on ABUS. The number of lesions detected in patients with multiple lesions were 106 from 169 on ABUS, 65 on FFDM, and 88 on CEM. The highest correlation between the lesion's margin and its histopathological character was found in FFDM (p < 0.00), then ABUS (p = 0.038), and the lowest in CEM (p = 0.043). Compliance in determining the lesions' size comparing to histopathology as a gold standard was the highest for ABUS (p = 0.258) and lower for CEM (p = 0.012).

Results: The sensitivity of ABUS, FFDM, and CEM was, respectively: 80.43, 90.22, and 93.48; specificity: 27.78, 11.11, and 11.11; positive predictive value (PPV): 85.06, 83.84, and 84.31; negative predictive value (NPV): 21.74, 18.18, and 25; and accuracy: 71.82, 77.27, and 80. The sensitivity and accuracy of the combination of FFDM and ABUS were, respectively, 100 (p = 0.02) and 84.55 (AUC = 0.947) and for the combination of FFDM + CEM 93.48 (p = 0.25) and 79.09 (AUC = 0.855).

Conclusions: The study confirms that both ABUS and CEM may serve as a valuable complementary method for FFDM.

Keywords: ABUS; CEM; breast cancer; mammography.

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Figures

Figure 1
Figure 1
Full-field digital mammography of both breasts in craniocaudal view; no abnormalities are to be seen
Figure 2
Figure 2
Contrast-enhanced mammography of both breasts in craniocaudal view of the patient from Figure 1. A strong and amorphic non mass enhancement is seen in the outer quadrant
Figure 3
Figure 3
Automatic breast ultrasound of the left breast of the same patient as in Figure 1 and Figure 2, coronal and axial view. An irregular mass with architectural distortion around is seen in the upper outer quadrant
Figure 4
Figure 4
Focal lesion sizes on full-field digital mammography (FFDM), automatic breast ultrasound (ABUS), and contrast-enhanced mammography (CEM)
Figures 5
Figures 5
Receiver operating characteristics (ROC) curves for full-field digital mammography (FFDM), contrast-enhanced mammography (CEM), automatic breast ultrasound (ABUS), ABUS + FFDM, and CEM + FFDM
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